Outcomes of Emergency Medical Patients Admitted to a Medical Surveillance Unit: a Retrospective Cross-Sectional Study

Abstract

High-acuity patients occasionally require advanced resources and monitoring, but do not qualify for intensive care admission in large intensive care unit (ICU). For these patients, intermediate care units (IMCUs) can provide adequate care. IMCUs lessen the patient burden for both the general ward and the ICU, allowing for more free beds in the ICU and ward. The main purpose of this study was to explore typical patient characteristics/demographics of patients admitted to an IMCU from the emergency room (ER) and mortality rate. This study is a retrospective cross-sectional study of a medical surveillance unit (MSU), which is an IMCU located in Pasqua Hospital, Regina. All patients admitted to the MSU from the ER in 2017 and 2018 were included in the study. This study retrospectively reviewed 715 patients in total. Patients’ age, sex, discharge disposition, comorbidities, primary and secondary diagnoses, admission and discharge date to/from the MSU, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, early assessment and response system (EARS) score, and acuity score were recorded. A total of 715 patient charts were reviewed for this study, with 323 patients in 2017 and 392 patients in 2018. Approximately a third of the study participants were diabetic, and half were hypertensive. Male sex had higher comorbidities including asthma or cerebrovascular accidents, and women had been diagnosed with coronary heart disease or liver disease. Both male and female were equally affected by substance use. 25.6% of the study population were smokers, 15.5% were intravenous drugs, and 16.8% were suffering with alcohol use disorder. Respiratory diseases account for a quarter of all primary diagnoses made in the MSU. Overall mortality rate was 5.9%. The APACHE II, EARS, and acuity scores were significantly different between deceased and alive patients (p < 0.001, p < 0.007, and p < 0.001, respectively). Half of the patients were discharged to home and a quarter were transferred to the ward. Nearly two-third of the study population was not readmitted to hospital within 30 days. This is one of the first studies to describe IMCU patients characteristics transferred from the ER in Canada. The APACHE II, EARS, and acuity scores were found significantly different between deceased and alive patients. These scores could therefore be used to develop tools that can identify high-risk patients for equitable allocation of healthcare resources to reduce mortality.